Postpartum care: What to expect after a vaginal delivery

Pregnancy changes your body in more ways than you might have guessed, and it doesn't stop when the baby is born. Here's what to expect after a vaginal delivery.

Vaginal soreness

If you had an episiotomy or vaginal tear during delivery, the wound might hurt for a few weeks. Extensive tears might take longer to heal. In the meantime, you can help promote healing:

If sitting is uncomfortable, sit on a pillow or padded ring.

Use a squeeze bottle to pour warm water over your vulva as you're urinating. Press a clean pad or washcloth firmly against the wound when you bear down for a bowel movement.

Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound.

Take pain relievers or stool softeners as recommended by your health care provider.

While you're healing, expect the discomfort to slowly improve. Contact your health care provider if the pain intensifies; the wound becomes hot, swollen and painful; or you notice a pus-like discharge.

Vaginal discharge

You'll have a vaginal discharge (lochia) for a number of weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. The discharge will gradually taper off, becoming watery and changing from pink or brown to yellow or white.

Contact your health care provider if:

You have heavy vaginal bleeding

The discharge has a foul odor

You have a fever of 100.4 F (38 C) or higher

Contractions

You might feel contractions, sometimes called afterpains, during the first few days after delivery. These contractions — which often resemble menstrual cramps — help prevent excessive bleeding by compressing the blood vessels in the uterus. These contractions tend to be stronger with successive deliveries. Your health care provider might recommend an over-the-counter pain reliever.

Contact your health care provider if you have a fever or if your abdomen is tender to the touch. These signs and symptoms could indicate a uterine infection.

Urination problems

Swelling or bruising of the tissues surrounding the bladder and urethra can lead to difficulty urinating. Fearing the sting of urine on the tender perineal area can have the same effect. Difficulty urinating usually resolves on its own. In the meantime, it might help to pour water across your vulva while you're sitting on the toilet.

Contact your health care provider if you have any signs or symptoms of a urinary tract infection. For example:

A strong, persistent urge to urinate

A burning sensation when urinating

Passing frequent, small amounts of urine

Pregnancy and birth stretch the connective tissue at the base of the bladder and can cause nerve and muscle damage to the bladder or urethra. You might leak urine when you cough, strain or laugh. Fortunately, this problem usually improves with time. In the meantime, wear sanitary pads and do Kegel exercises to help tone your pelvic floor muscles.

To do Kegels, tighten your pelvic muscles as if you're stopping your stream of urine. Try it for five seconds at a time, four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Aim for at least three sets of 10 repetitions a day.

Hemorrhoids and bowel movements

If you notice pain during bowel movements and feel swelling near your anus, you might have hemorrhoids — stretched and swollen veins in the anus or lower rectum. To ease any discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider might recommend a topical hemorrhoid medication as well.

If you find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound, take steps to keep your stools soft and regular. Eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Ask your health care provider about a stool softener or an osmotic laxative, if needed.

Another potential problem for new moms after a vaginal delivery is the inability to control bowel movements (fecal incontinence). Frequent Kegel exercises can help with mild fecal leakage. If you have persistent trouble controlling bowel movements, consult your health care provider.

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